Provider Demographics
NPI:1568954071
Name:ROBERTS, JORDAN ALLEN (DPT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ALLEN
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-541-5492
Mailing Address - Fax:
Practice Address - Street 1:8254 HIGH ST NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1923
Practice Address - Country:US
Practice Address - Phone:330-856-2476
Practice Address - Fax:234-600-5661
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017471225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist